Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.
Acta Oncol. 2023 Jan;62(1):89-99. doi: 10.1080/0284186X.2023.2173536. Epub 2023 Feb 7.
Prior studies of suicide risk among prostate cancer patients are conflicting. We compared the risk of suicide in prostate cancer patients to cancer-free men including adjustment for clinical stage, socioeconomic position, somatic comorbidity, and previous depression.
A cohort of 37,527 men diagnosed with prostate cancer in Denmark during 1998-2011 was identified in the Danish Prostate Cancer Registry (DaPCaR) and compared with 357,384 cancer-free men matched by age at the time of diagnosis. The primary outcome was death from suicide. Data were analyzed using cumulative incidence functions and multivariable Cox regression models.
Among prostate cancer patients, 3813 had a previous depression, defined as filed antidepressant prescription within three years before diagnosis. In the study period, 108 prostate cancer patients were registered with suicide as the cause of death, hereof 26 with previous depression. There was no difference in the cumulative incidence of suicide between prostate cancer patients and cancer-free men. There was no effect modification of previous depression on the risk of suicide ( = .12). The hazard ratio (HR) for suicide varied with time since diagnosis. A sensitivity analysis showed that the risk of suicide was highest within the first year of diagnosis where prostate cancer patients had a 1.70-fold increased hazard compared with cancer-free men (95% CI, 1.11-2.59). Men with prostate cancer and previous depression had a three-fold increased hazard for suicide compared with prostate cancer patients without a history of depression (HR 2.84, 95% CI, 1.82-4.45).
The absolute risk of suicide is low following a prostate cancer diagnosis. Time since diagnosis and a history of depression was associated with the highest risk of suicide. Healthcare professionals should be aware of an increased risk of suicide among men with previous depression, especially in the immediate aftermath of the diagnosis.
先前关于前列腺癌患者自杀风险的研究结果相互矛盾。我们比较了前列腺癌患者和无癌症男性的自杀风险，包括对临床分期、社会经济地位、躯体合并症和既往抑郁的调整。
在丹麦前列腺癌登记处（DaPCaR）中确定了 1998-2011 年间诊断出的 37527 名前列腺癌患者队列，并与按诊断时年龄匹配的 357384 名无癌症男性进行比较。主要结局是自杀死亡。使用累积发生率函数和多变量 Cox 回归模型进行数据分析。
在前列腺癌患者中，3813 人有既往抑郁史，定义为在诊断前三年内有抗抑郁药处方。在研究期间，有 108 名前列腺癌患者被登记为自杀死亡，其中 26 人有既往抑郁史。前列腺癌患者和无癌症男性的自杀累积发生率没有差异。既往抑郁对自杀风险没有影响修饰作用（ = .12）。自杀风险随诊断后时间而变化。一项敏感性分析显示，在诊断后的第一年，自杀风险最高，与无癌症男性相比，前列腺癌患者的危险比（HR）增加了 1.70 倍（95%CI，1.11-2.59）。与没有抑郁病史的前列腺癌患者相比，有前列腺癌和既往抑郁史的男性自杀风险增加了三倍（HR 2.84，95%CI，1.82-4.45）。
前列腺癌诊断后自杀的绝对风险较低。诊断后时间和既往抑郁与自杀风险最高相关。医疗保健专业人员应意识到既往抑郁的男性自杀风险增加，尤其是在诊断后立即。
